Circulation, Vol 76, 142-154, Copyright © 1987 by American Heart Association
JH Chesebro, G Knatterud, R Roberts, J Borer, LS Cohen, J Dalen, HT Dodge, CK Francis, D Hillis and P Ludbrook
Intravenous administration of 80 mg of recombinant tissue plasminogen
activator (rt-PA, 40, 20, and 20 mg in successive hours) and streptokinase
(SK, 1.5 million units over 1 hr) was compared in a double-blind,
randomized trial in 290 patients with evolving acute myocardial infarction.
These patients entered the trial within 7 hr of the onset of symptoms and
underwent baseline coronary arteriography before thrombolytic therapy was
instituted. Ninety minutes after the start of thrombolytic therapy,
occluded infarct-related arteries had opened in 62% of 113 patients in the
rt-PA and 31% of 119 patients in the SK group (p less than .001). Twice as
many occluded infarct-related arteries opened after rt-PA compared with SK
at the time of each of seven angiograms obtained during the first 90 min
after commencing thrombolytic therapy. Regardless of the time from onset of
symptoms to treatment, more arteries were opened after rt-PA than SK. The
reduction in circulating fibrinogen and plasminogen and the increase in
circulating fibrin split products at 3 and 24 hr were significantly less in
patients treated with rt-PA than in those treated with SK (p less than
.001). The occurrence of bleeding events, administration of blood
transfusions, and reocclusion of the infarct-related artery was comparable
in the two groups. Thus, in patients with acute myocardial infarction,
rt-PA elicited reperfusion in twice as many occluded infarct-related
arteries as compared with SK at each of seven serial observations during
the first 90 min after onset of treatment.
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